Omalizumab in three children with severe vernal keratoconjunctivitis
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Omalizumab in three children with severe vernal keratoconjunctivitis Siri Rossberg1, Uwe Pleyer2, Susanne Lau1 Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany; 2Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany 1
Summary Keywords allergic c onjunctivitis, atopic derma titis, IgE, allergic asthma, therapy
Submitted April 15, 2020 Accepted April 27, 2020 Online-Version http://link.springer. com/journal/40629 Literaturreferat dieser Arbeit auf Deutsch: Seite 12
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Background: Vernal keratoconjunctivitis (VKC) is a rare, recurrent form of ocular allergy that can be refractory to topical and systemic treatment. It typ ically presents as acute and chronic keratoconjunc tival inflammation that may lead to visual impair ment due to corneal ulcers and scaring. Patients often suffer from atopic IgE-driven comorbidities, especially atopic eczema. Children are frequently affected and often do not tolerate topical treatment well, especially if photophobia and pain impair therapy adherence. We present three children with severe VKC who were not controlled by first- and second-line topical and systemic therapy and finally responded to treatment with the monoclonal antiIgE antibody omalizumab as third-line treatment. Methods and results: We retrospectively analyzed three patients with VKC having failed response to first- and second-line treatment. All three boys had very early allergic rhinoconjunctivitis from age 1–3 with polysensitization: birch, grass pollen, house dust mite, and/or pets. All received subcutaneous or sub lingual immunotherapy (SCIT/SLIT) for birch and/ or grass pollen without major success. Two patients had comorbidities: allergic asthma and severe atopic
dermatitis (AD). For at least 6 months after the first administration, monoclonal anti-IgE antibody omalizumab (150 or 300 mg) was administered sub cutaneously every 2–6 weeks in all patients achieving improvement of the clinical grading scale from VKC grade 3–4 to grade 1–2. One patient had a relapse mainly of his AD and achieved complete control of AD and VKC by introduction of dupilumab. Conclusion: Although the clinical benefit of omali zumab in asthma and chronic spontaneous urticaria (CSU) has been established in several clinical trials, there are very little data about its effect on severe VKC. In addition to few previously reported cases we can report the rapid effectiveness of o malizumab in VKC clinically and in terms of quality of life. Randomized trials are needed to include omali zumab in third-line treatment of VKC for preven tion of visual impairment and further sequelae such as corneal damage.
Introduction
in young males without eyelid involvement in contrast to AKC showing additional blepharo conjunctivitis [2]. An Italian prospective study (pa tients 3–100 years of age) estimated a VKC preva lence of 6.5 %; 64.5 % of these patients were under 14 years of age [3]. VKC occurs with three main presentations
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